Fontan 수술후 저심장박출증 및 지속성 흉막 삼출액이 발생되는 해부생리학적 원인

한재진,서경필,Han, Jae-Jin,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.2

We have experienced 62 cases of modified Fontan operations in Seoul Nat’l University Hospital from Apr. 1986 to Jul. 1989, They were 38 males and 24 females, and their age was ranged from 16 months to 15.5 years of age. [mean age : 5.73$\pm$2.99 years] There were 16 operative deaths and 2 late deaths, therefore 29% of overall mortality. Their diagnoses were as follows; 28 single ventricle, 11 tricuspid atresia, 6 DORV with LV hypoplasia, 3 pulmonary atresia with hypoplastic RV, 3 TGA with hypoplastic RV, 3 cor\ulcornerGA with hypoplastic LV and PA, 6 AV canal defects with PA, and 2 others. Low cardiac output and pleural effusion were developed frequently, so we divide 40 patients into some groups to analyze the physiologic and anatomic causes of them. By the degree of the LCO, group A was no LCO[mean amount of inotropics used: 0-5 \ulcornerg/kg/min] with 17 cases, B mild LCO [5-10] with 11, C moderate to severe LCO but alive[>10] with 8, D severe LCO to death with 4 cases. For the pleural effusion, group 1 was to be removed the chest tube within 1 week with 8 cases, group II within 3 weeks with 21 cases, group III beyond 3 weeks with 12 cases. We considered their age, diagnosis, pulmonary artery size[PA index], pulmonary artery abnormality, palliative shunt, systemic ventricular type, pulmonary artery wedge pressure, as preoperative factors, and operative methods, and as postoperative factors, CVP, LAP, arrhythmia, thrombosis, atrioventricular valvular insufficiency, etc. In the view of LCO, pulmonary artery size and PCWP were statistically significant [P<0.05], and arrhythmia, A-V valve insufficiency were inclined to the group C and D Pleural effusion was influenced by the pulmonary artery size, pulmonary artery resistance, PCWP, and CVP significantly. [P<0.05] And arrhythmia, residual shunt, and A-V valvular insufficiency were inclined to group II and III, too. As a results, the followings are to be reminded as the important factors at the care of post-Fontan LCO, and persistent pleural effusion [1] pulmonary artery size, [2] pulmonary artery resistance, [3] PCWP, [4] CVP, [5] arrhythmia, [6] residual shunt, [7]A-V valvular insufficiency.

Celestin Tube 를 이용한 진행된 식도암환자에서의 고식적 수술치료 - 6례보고-

한재진,조재일,심영목,Han, Jae-Jin,Jo, Jae-Il,Sim, Yeong-Mok 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.2

Dysphagia is common symptom in patients with advanced esophageal cancer, which is not to be resected surgically. Especially when esophagorespiratory fistula is complicated, it leads to rapid deterioration and death due to pulmonary infection. Esophageal intubation relieves dysphagia as simple surgical execution and offers rapid effectiveness. For six patients with inoperable esophageal cancer including three esophago-respiratory fistulas, the palliative esophageal intubation was performed in Korea Cancer Center Hospital, in 1988. Traction technique via high gastrotomy with Celestin tube was used. Adequate palliation of dysphagia was achieved in 5 patients, but wound infection was developed in 2 patients, tube migration in 2 patients, and 2 died in hospital due to sepsis on the 16th and 42nd postoperative day, respectively. In 3 patients with esophagorespiratory fistula complicated after radiation therapy, the intubation was performed urgently and the result was satisfactory in 2 of them that the fistula was occluded successfully and aspiration or pulmonary infection was prevented.

외국 의과대학에서의 성과중심교육과정 개발

한재진,Han, Jae-Jin 연세대학교 의과대학 2013 의학교육논단 Vol.15 No.1

In medicine, rapid changes in information, technology, socio-economic interests, and globalization affect the medical education focused on the competencies of doctors, and the number of medical schools that are adopting an outcome-based curriculum (OBC) is increasing worldwide. This paper introduces the OBC model of 5 trailblazing medical schools from the UK, US, and Australia, comparing their unique features, followed by brief comment about Canada and the EU as well. On developing an OBC, the process of establishing the top outcomes for graduates is similar and the outcomes comprise knowledge, skills, and attitudes about science, patients, colleagues, society, and themselves. Implementing the outcomes down into the sub-levels of the curriculum is much more complicated and time-consuming. Assessing the achievement of every outcome is essential and requires the use of many tools in addition to the traditional written examination. From the perspective of adult learning theory, self-directed learning, team-learning, and individual and flexible achievement are tested and executed in an OBC. The gradual expansion and further innovation of an OBC is expected so that tomorrow's doctors will be able to meet the challenges of the future.

식도천공의 외과적 치료

한재진,성숙환,김주현,Han, Jae-Jin,Seong, Suk-Hwan,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

폐혈류감소를 동반한 선천성 심장기형에서 술전 폐동맥발육과 조기 술후 혈역학적 변화와의 관계

한재진,김용진,Han, Jae-Jin,Kim, Yong-Jin 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4

We sought the relationship between the pulmonary artery development and cardiac performance from the analysis of the 36 cyanotic congenital heart disease patients [mainly TOF] who were operated and indwelled the pulmonary artery and left atrial pressure monitoring catheters for the postoperative care at the department of Thoracic and Cardiovascular Surgery SNUH in 1988. They were pre-evaluated of the pulmonary artery index from the cineangiographic films and post-operatively, calculated the cardiac index from the arterial and mixed venous blood gas and also measured the mean left atrial pressure and total inotropic supporting amount after operation. The post-operative cardiac indices were 3.46 * 1.03 1/min/M2 [immediate postoperative], 3.31 [ 1.08 [postoperative 6 hrs], 3.29 [ 1.01 [12 hrs], 3.54 * 1.02 [24 hrs], 3.92 * 1.14 [48 hrs], respectively. We divided the patients the group A and group B from the size of the pulmonary artery index, that is, group A was below 200 mm2/M2 and group B above 200 mm2/M2 of the pulmonary artery index. The cardiac indices and left atrial pressure between the group A and B were not different in the view of the statistical significance but the total post-operative inotropic amount of group A was more than group B and it was significant statistically. We concluded that the smaller the pulmonary artery index is, the more postoperative supportive treatment [for example, inotropics] for the enhancement of cardiac performance is needed, and indirectly, which means that the pulmonary artery index was correlated with the postoperative cardiac performance in cyanotic congenital heart disease.

소아에서 인공심폐기 충전액의 첨가용액으로서 사용한 crystalloid와 colloid 용액에 관한 임상연구

한재진,서경필,Han, Jae-Jin,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.5

Searching for the clinical effects of colloid solutions that used to increasing the oncotic pressure of priming solutions at the cardiopulmonary bypass, 29 patients [who were diagnosised as simple VSD around 10kg of body weight and scheduled to be operated from June 1990 to December 1990 at Sejong General Hospital] were divided randomly and prospectively to the two groups: A group [15] was received 4gm% albumin as addition to the priming solutions and B Group [14] the same amount of Ringer`s lactated solution. 34 clinical parameters [Body weight, sex, age, body surface area, Qp/Qs, pulmonary arterial pressure, cardiopulmonary bypass time, anesthetic time, intraoperatively infused crystalloid and colloid amount, hemoglobin, hematocrit, serum sodium concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum protein, serum albumin concentration, urine output, central venous pressure, postoperatively infused colloid amount, immedediate post-operative peak inspiratory pressure, cardiac index, blood pressure and pump flow during cardiopulmonary bypass, inotro-pic assist, diuretics, extubation period, total drain amount, duration of ICU] were measured and compaired between the two groups. There were no differences of preoperative and operative clinical parameters. And postoper-atively, practically there were no nearly differences at the clinical outcomes between the two groups, but some parameters [cardiac index, PIP, BP and pumpflow during CPB, etc] contributed to being preferable to the Group A at certain times [P<0.05]. Conclusively, it might be thought that the priming solution of cardiopulmonary bypass added by colloid solution had some beneficial effects on the patients, especially younger and associated with complex anomaly to be expected taken longer time of cardiopulmonary bypass, and more studies about the neonatal and complex anomaly cases were needed in that points.

우리나라 의사양성체제의 관점에서 본 의과대학 교육의 문제점과 개선방향

한재진,Han, Jae Jin 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.2

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

아급성 심내막염을 동반한 대동맥륜 하부 대동맥류의 수술치험 -1례 보고-

한재진,이원용,채헌,Han, Jae-Jin,Yi, Won-Yong,Chae, Hurn 대한흉부심장혈관외과학회 1989 The Korean Journal of Thoracic and Cardiovascular Vol.22 No.6

Subannular aortic aneurysm is a word-wide rare disease entity occurring predominantly in young black men. In Korea, there has been no report. We report one patient, 46 years old man, who had been operated urgently because of acute aortic insufficiency and aortic valvular vegetation after antibiotics treatment of Subacute bacterial endocarditis for 6wks. At the operative field, We found the bulging aneurysmal mass between the aorta and superior vena cava above the right pulmonary artery, which has subannular communicating opening into the left ventricular cavity, beneath the anterior commissure of the bicuspid aortic valve. Pathologic findings are consistent with "portion of vascular wall with features of aneurysm.* The patients survived aortic valve replacement and patch closure of subannular aneurysm, with no symptoms at one-year postoperative follow-up.w-up.

중국 주식시장의 변동성과 환율 및 이자율간의 상관성 분석

한재진 ( Jae Jin Han ) 한중사회과학학회 2009 한중사회과학연구 Vol.7 No.1

This study tries to find the correlation and causality between China`s share prices, exchange rate and credit spread, while the Shanghai index was on a falling tendency from 4 January 2006 to 31 December 2008. Based on VAR model the Johansen co-integration test is performed in order to measure long-term equilibrium relationship between three variables, and then set up the VECM(Vector Error Correction Model). In addition, analyze causality between three variables using Impulse Response, Variance Decomposition and Granger Causality test. As a result, the correlation of stock prices and exchange rates or credit spread show negative and positive correlation in the entire period and the rising phase(January 4, 2006~November 21, 2007), and stock prices at the relationship between two variables show positive correlation in the downward period(November 22, 2007~December 31, 2008). Also, Johansen co-integration Test shows that there exist equilibrium relationship in this all-time series. Finally, Granger Causality test shows that exchange rate has lead relationship in the entire period and rising phase. But in the downward period stock prices have lead relationship. Therefore, this study shows that the change of China`s exchange rate influences other variables very closely. So we can expect the future policy direction of china will be changed through the exchange rate.

중국 주식시장과 외환시장 간의 동태적 관계 분석

한재진 ( Jae Jin Han ) 현대중국학회 2010 現代中國硏究 Vol.12 No.1

본 논문은 중국의 주식시장과 외환시장 간의 인과관계, 장기적 균형관계 및 가격이전효과(price spillover effect)와 변동성이전효과(volatility spillover effect)를 분석하였다. 기간은 2000년부터 2009년 말까지 일별자료를 사용하였으며, 2005년 7월 21일부터 실시된 위안화 환율기제 시행 전·후를 각각 1, 2기로 나누어 분석하였다. 분석은 그랜저 검정을 통해 인과성을 검토한 후 VAR 모형을 바탕으로 충격반응함수를 도출하고 E-GARCH 모형을 통해 가격 및 변동성 이전효과를 살펴봄으로써 최근 위안화 환율절상의 가능성과 주식시장과 외환시장 상호간 연계성을 판단해 보았다. 분석결과 위안화 환율기제 개혁 이후부터 외환시장에서 주식시장으로의 선행적 인과성이 나타났으며, 충격반응함수로 추정 결과 환율이 상승할 때 주가도 상승하는 것으로 나타났다. 하지만 장기적인 균형관계를 보이고 있지 않았다. 가격이전효과에서는 위안화 환율개혁 이후부터 주식시장에서 외환시장으로 나타나고는 있지만 통계적으로 큰 의미를 찾을 수 없었고, 비대칭적 변동성이전효과에서는 위안화 환율기제 개혁이전에는 주식시장과 외환시장 상호 간 이전효과가 존재했지만 개혁 이후부터 주식시장에서 외환시장으로의 이전효과만 존재하는 것으로 나타났다. 즉, 주식시장의 음의 정보에 외환시장이 민감하게 반응하고 있는 것으로 나타났다. 결과적으로 이러한 분석결과로 볼 때, 향후 위안화 환율기제 변화에 대해 시장의 위험 발생 가능성은 낮은 것으로 추정할 수 있다. This paper investigates the dynamic relationship between China`s stock prices index and Rmb/Dollar exchange rate using the daily closing prices covered from January 4, 2000 to December 31, 2009. Based on VAR(Vector-Auto Regression) model the co-integration test is performed in order to measure long-term equilibrium relationship between two variables. In addition analyze causality between two variables using Impulse Response Function test. And applies E-GARCH(Exponential generalized ARCH) model, this paper tries to answer the question whether price and volatility spillover effect exist between stock markets and foreign exchange markets. The main empirical results are as follows. First, we found that there exist causal relationship from foreign exchange markets to stock markets for the post-RMB exchange rate regime reform period. And using the Co-integration test we found that there are no long-run equilibrium relationship between stock prices and exchange rates in this period. Second, EGARCH analysis shows that there are dynamic interdependence between foreign exchange markets and stock markets for the post-RMB exchange rate regime reform period. And regarding volatility spillover effect, our findings indicate that volatility spillover effect from stock markets to foreign exchange markets is asymmetric. Finally, based on the results, mechanism of RMB exchange rate changes that may occur as the potential risks of the market can be assumed that low.